Endobronchial hamartoma

Malignant and Benign Tracheobronchial Neoplasms: Comprehensive Review with Radiologic, Bronchoscopic, and Pathologic Correlation

Tracheobronchial neoplasms are much less common than lung parenchymal neoplasms but can be associated with significant morbidity and mortality. They include a broad differential of both malignant and benign entities, extending far beyond more commonly known pathologic conditions such as squamous cell carcinoma and carcinoid tumor. Airway lesions may be incidental findings at imaging or manifest with symptoms related to airway narrowing or mucosal irritation, invasion of adjacent structures, or distant metastatic disease. While there is considerable overlap in clinical manifestation, imaging features, and bronchoscopic appearances, an awareness of potential distinguishing factors may help narrow the differential diagnosis. The authors review the epidemiology, imaging characteristics, typical anatomic distributions, bronchoscopic appearances, and histopathologic findings of a wide range of neoplastic entities involving the tracheobronchial tree. Malignant neoplasms discussed include squamous cell carcinoma, malignant salivary gland tumors (adenoid cystic carcinoma and mucoepidermoid carcinoma), carcinoid tumor, sarcomas, primary tracheobronchial lymphoma, and inflammatory myofibroblastic tumor. Benign neoplasms discussed include hamartoma, chondroma, lipoma, papilloma, amyloidoma, leiomyoma, neurogenic lesions, and benign salivary gland tumors (pleomorphic adenoma and mucous gland adenoma). Familiarity with the range of potential entities and any distinguishing features should prove valuable to thoracic radiologists, pulmonologists, and cardiothoracic surgeons when encountering the myriad of tracheobronchial neoplasms in clinical practice. Attention is paid to any features that may help render a more specific diagnosis before pathologic confirmation. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Severe Central Airway Obstruction Secondary to a Giant Endobronchial Hamartoma: A Case Report

Central airway obstruction refers to the occlusion of more than 50% of the trachea, main stem bronchi, or lobar bronchus. It can potentially become a life-threatening condition. Pulmonary hamartomas (PH) are rare tumors with an incidence of 0.25%, constituting about 8% of all benign lung neoplasms. Only 10% of PH occur endobronchially, while the remaining appear peripherally. We present the case of a women with an endobronchial hamartoma that required emergent resection by bronchoscopy. This is 44-year-old woman, with a history of an endobronchial mass on the right main stem bronchus (RMSB) without histopathological diagnosis or surgical management. She presented with a history of chronic cough and expectoration. Upon admission, a chest X-ray was performed, showing opacities of the right lung and amputations of the RMSB. Bronchoscopy was performed and a tumor-like mass that occludes the RMSB was found, with valve effect causing intermittent occlusion. In anesthetic induction, she presents severe airway obstruction and cardiorespiratory arrest. During resuscitation maneuvers, the lesion that was obstructing the light is seen and resection was performed with electrocautery and cryotherapy probes. Histopathological report described an endobronchial chondromesenchymal hamartoma, with no signs of malignancy. The control X-ray showed adequate re-expansion of the right lung. In conclusion, although endobronchial hamartoma has a low incidence and has a slow growth rate, it can manifest as severe airway obstruction. To achieve a complete resection of an endobronchial lesion, both rigid and/or flexible bronchoscopy plus multimodal interventions are recommended.

Tracheal Hamartoma: A Case Report

Hamartoma is the most frequently observed benign lung tumor, but its tracheal form is still exceptionally encountered. Cough, dyspnea, hemoptysis, and chest pain are all possible symptoms of tracheal hamartoma. The non-specific symptoms may also lead to a delayed diagnosis, and while the choice of treatment varies depending on the size and location of the lesion, conservative treatments remain strongly recommended. This report presents the case of a 57-year-old male who presented to our department with inspiratory dyspnea. Clinico-radiological data and bronchoscopy revealed a benign tracheal tumor of the lipomatous hamartoma type. The patient underwent a tumor resection by rigid bronchoscopy with satisfactory clinical results.

Hamartochondroma Pleural Lesion Mimicking Liposarcoma: A Case Report

Heterogeneous masses developing in the pleural cavity are most often malignant and can pose diagnostic challenges. Fibrous tumors of the pleura, liposarcoma, thymoma or lipoma most frequently affect this anatomic area. Surgical exploration and resection are often mandatory to make the definitive diagnosis. We report the case of a 54-year-old women who presented with an epigastric and right sub costal pain. A complete preoperative workup revealed a large tissular and fatty mass in the right costo-diaphragmatic angle suggestive of liposarcoma. Surgical resection resulted in the surprising diagnosis of hamartochondroma.

Endobronchial hamartoma in a young COVID-19 symptomatic woman. Radical endoscopic treatment with a disposable bronchoscope. Case Report

Pulmonary hamartomas represent the most frequent family of benign lung tumors that typically involve the lung parenchyma and only rarely grow as endobronchial tumors. The elective treatment of endobronchial hamartoma is the bronchoscopic resection, and in those cases in which tumor extension and localization makes it not possible, surgical treatment must be evaluated. Patients with symptomatic COVID-19, hospitalized, frequently undergo a chest CT scan and in some cases, occasional findings may emerge, requiring diagnostic investigations such as bronchoscopy and interventional pulmonology procedures. Therefore, in such a delicate pathological condition, such as COVID-19, the need to perform bronchoscopy and interventional pulmonology procedures, minimizing the risk of viral transmission and ensuring necessary assistance, represents a great challenge for pulmonologists. In this article authors describe, for the first time in literature, a rare case of endobronchial hamartoma, radically resected using a single use bronchoscope, in a young female patient hospitalized for symptomatic COVID-19.

Benign tumours of the bronchopulmonary system

The vast majority of tumours arising in the bronchopulmonary system are malignant in nature. Benign tumours of the lung are relatively rare and are often incidental findings during clinical investigations for unrelated conditions. These lesions can arise in the bronchial tree or the pulmonary parenchyma and may be of epithelial, mesenchymal, salivary gland-type or unknown differentiation. Although the spectrum of these lesions is wide, the clinical, pathological and immunohistochemical characteristics of the most relevant will be the subject of this review. In addition, the most important features allowing differentiation from malignant pulmonary neoplasms will be discussed.

Interlobar Pulmonary Hamartoma With an Unusual Neighboring Lesion: A Case Report

Pulmonary hamartomas are benign lung tumors. They are uncommon and represent a small percentage of all solitary lung lesions. Hamartomas are composed of an abnormal mixture of epithelial and mesenchymal elements. They are usually discovered incidentally as patients are asymptomatic in most cases. On the other hand, sclerosing pneumocytomas are rarely discovered and are one of the most uncommon benign lung tumors. Herein, we present the case of a 37-year-old female who presented with hemoptysis. A computed tomography scan of her thorax revealed a right-sided round lesion in the interlobar fissure with no additional findings. Surgical excision was performed, which demonstrated an uncommon and unique finding of a pulmonary hamartoma coexisting with a sclerosing pneumocytoma found on exploration. This highlights the importance of exploration during surgical procedures in order identify missed lesions on imaging.

Endobronchial treatment of benign endobronchial neoplasms: Our 10 years of experience

Background

The aim of the study was to assess the safety, efficacy, complications, and long-term outcomes of endobronchial treatment for benign endobronchial tumors.

Methods

A total of 53 patients (39 males, 14 females; mean age: 53.7 years; range, 12 to 83 years) with the diagnosis of benign endobronchial neoplasms in our center between November 2010 and September 2019 were retrospectively analyzed. Data including demographic and clinical characteristics of the patients and treatment outcomes were examined.

Results

Tumors regressed in all patients with argon plasma coagulation, diode laser and electrocautery, which was combined with cryotherapy in some cases. Complications were observed in five (9%) patients. Major complications were atrial fibrillation in two patients and respiratory failure requiring mechanical ventilation in one patient. Minor complications were minimal bleeding in two patients. The response was very good in 39 (74%) patients and good in 12 (23%) patients. There was no significant difference in the residual tissue formation requiring cryotherapy among the endobronchial treatment modalities (p>0.05). The five-year survival rate was 94%. No endobronchial treatment-related mortality was observed in any of the patients.

Conclusion

Endobronchial treatment modalities including diode laser, electrocautery, and argon plasma coagulation combined with or without cryotherapy are effective and safe in the treatment of benign endobronchial tumors.

Smooth Muscle Conditions of the Chest: A Clinical, Radiologic, and Pathologic Review

Smooth muscle conditions of the chest have diverse clinical and imaging manifestations and may involve nearly every thoracic structure. Differentiation among these conditions requires the integration of clinical, radiologic, and histopathologic data. Histologic examination in conjunction with immunohistochemistry is essential for differentiation from other spindle cell neoplastic mimics. Familiarity with these entities will ensure the inclusion of smooth muscle conditions in the differential diagnosis of thoracic soft tissue lesions and potentially guide the clinician in appropriate management. We review the clinical, imaging, and histopathologic features of thoracic smooth muscle-related conditions organized by the anatomic structures affected.

[Confusion in the diagnosis of endobronchial tumor]

Le cancer broncho-pulmonaire représente la première cause de décès par cancer chez l´homme et le deuxième chez la femme. Certaines présentations endoscopiques ou radiologiques peuvent orienter le diagnostic histologique et ainsi faciliter la prise en charge thérapeutique. Nous rapportons l´observation d´un homme de 54 ans, tabagique, coronarien récemment stenté, consultant pour hémoptysie et aggravation de sa dyspnée évoluant depuis un mois. Sa radiographie du thorax avait objectivé une hyperclarté de l´hémichamp pulmonaire gauche avec des signes de rétraction. A la fibroscopie bronchique, il existait une formation bourgeonnante framboisée, saignant spontanément, accouchée par la bronche souche gauche évoquant une tumeur carcinoïde. Le scanner thoracique avait objectivé un processus tissulaire endoluminal, au niveau de la bronche souche gauche situé à quatre cm de la carène, peu rehaussé au produit de contraste et compliqué d´atélectasie. Une chirurgie diagnostique et thérapeutique a permis de redresser le diagnostic en faveur d´un hamartochondrome endobronchique.

Cryodebulking of endobronchial hamartoma via fibreoptic bronchoscopy and literature review

Endobronchial hamartoma is a rare tumour. We report a 65-year-old woman with a history of recurrent pneumonia. Bronchoscopy revealed a 1 cm endobronchial mass obstructing the left upper lobe bronchus. Histopathological examination was consistent with a pulmonary hamartoma. This lesion was successfully debulked endoscopically with the use of a flexible cryoprobe without any complications. This case highlights both the importance of investigating recurrent pneumonia and the usefulness of endoscopic recanalisation in an obstructed segmental bronchus.

[Hamartochondroma: An unusual cause of endobronchial obstruction in smoking patients]

Endobronchial hamartochondroma is a rare benign tumor which differs from the parenchymal form in its symptomatology and also by its treatment which should be as conservative as possible. The endobronchial location is exceptional. Here we present the cases of two patients with endobronchial hamartochondroma associated with clinical manifestation, chest pain and repeated pulmonary infections, respectively. The diagnosis was made after performing a CT-scan, a PET-SCAN and histological analysis. After discussion in a multidisciplinary staff meeting, conservative treatment was chosen in both cases.

Peripheral pulmonary hamartoma with haemoptysis from the non-adjacent bronchus

We report a rare case of peripheral pulmonary hamartoma that caused haemoptysis from the non-adjacent bronchus. A 54-year-old man was admitted to our hospital because of haemoptysis. Contrast-enhanced chest computed tomography revealed a tumour measuring 25 × 24 mm in the left lower lobe. Fluid was observed around the pulmonary artery in addition to the consolidation of the lingular segment of the left lung. Bronchoscopy confirmed continuous bleeding from the lingular bronchus, and surgery was planned. The patient was promptly diagnosed with pulmonary hamartoma intraoperatively, and tumour enucleation was performed. The haemoptysis resolved after surgery, and the patient was discharged on post-operative day 10. As peripheral hamartoma does not generally cause haemoptysis, we suspected that the haemoptysis occurred due to the unusual condition in which the bleeding from the tumour reached the non-adjacent lingular branch along the pulmonary artery sheath.

Efficacy and safety of flexible endoscopic intervention via laryngeal mask airway for endobronchial hamartoma removal

OBJECTIVE

To evaluate the clinical characteristics, efficacy and safety of flexible endoscopic intervention for endobronchial hamartoma.

MATERIAL AND METHODS

Thirteen patients with endobronchial hamartoma who underwent flexible endoscopic intervention at a single center were analyzed retrospectively. The clinical characteristics and efficacy of flexible endoscopic intervention were described.

RESULTS

Nine patients were cured after one single flexible endoscopic intervention, three patients underwent second flexible endoscopic interventions due to late tumor recurrence, while one patient who eventually became stable with a 40% stenosis of the airway lumen, received a third intervention because of two relapses. Pneumothorax occurred in one patient who was cured after oxygen therapy. There were no serious complications such as massive hemorrhage, airway perforation, airway ignition and suffocation associated with the therapy.

CONCLUSIONS

Flexible endoscopic intervention appeared to be safe and effective for the treatment of patients with endobronchial hamartoma.

Conversion to thoracotomy during VATS segmentectomy for treatment of symptomatic endobronchial hamartoma

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Endobronchial hamartomas are rare benign tumors.

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Surgical resection is recommended in patients with end stage lung injury or extra bronchial spread lesion.

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In presence of extra bronchial spread lesion, surgical team should keep in mind the possibility of potential vascular injury.

Introduction

Most hamartomas are located peripherally in the lung parenchyma and are rarely identified as an endobronchial lesion. Clinically patients with an endobronchial hamartoma are often symptomatic and may present with various symptoms including: fever, wheezing, hemoptysis and obstructive pneumonia.

Case presentation

A 68-year-old man presented with complaints of fever and cough for 1 month. Chest X-ray revealed a right infrahilar density, which on chest CT was found to be a lesion obstructing the superior segmental bronchus of the right lower lobe and extending outside of the bronchus. A round rubbery mass obstructing the same segmental bronchus was noticed during bronchoscopy and endoscopic biopsy yielded a pathological diagnosis of hamartoma.

Discussion

Bronchoscopy is most helpful in diagnosis and management of endobronchial hamartomas but if the lung distal to the obstruction is irreversibly damaged or imaging studies suggest that tumor extends outside of the bronchus, pulmonary segmentectomy, lobar resection or even pneumonectomy may be indicated.

Conclusion

When a benign tumor of the lung, as endobronchial hamartoma, is located in a segmental bronchus and presents extrabronchial spread, we recommend to perform a parenchymal-sparing surgical resection. In this case surgical team, however, should keep in mind, due to difficult individual dissection of the segmental bronchovascular elements, the possibility of conversion from VATS (video-assisted thoracic surgery) to open thoracotomy.

An unusual pneumonia

A 70-year-old patient presented to the emergency department with a productive cough and fever for 15 days. He had no general status alteration, no chest pain, no dyspnoea, no haemoptysis and no other symptoms. He was a current cigar smoker, with a >20 pack-years smoking history, and had a past medical history of high blood pressure treated with telmisartan and a polypectomy for benign colon polyp 1 year ago. He had no professional exposures. He was French and had lived in Hanoi, Vietnam, for >10 years.

Can you diagnose this clinical case of a rare disease presenting as a very common disease?http://ow.ly/Trzu30kGzk6

Successful use of snare electrocautery via flexible fiberoptic bronchoscopy for removal of an endobronchial hamartoma causing chronic lung atelectasis and mimicking malignancy

We present a rare case of giant endobronchial hamartoma coexisting with lung atelectasis for more than 3 years. The small specimen initially biopsied via bronchoscope did not reveal tissue features, but some features were suspicious for squamous cell carcinoma. The lesion was removed completely using snare electrocautery combined with argon plasma coagulation via flexible fiberoptic bronchoscopy. The patient made a satisfactory recovery, and a pathological diagnosis was made. This could be a useful option in selected endobronchial tumors.

Endobronchial hamartoma mimicking malignant lung tumor contralateral endobronchial metastasis: A case report

RATIONALE

Endobronchial hamartoma, the most common benign lung tumor, is located in the bronchus, and it easily mimics lung cancer or bronchial metastasis. Endobronchial hamartoma can cause coughing, hemoptysis, and pulmonary infection; thus, it should be treated right away by surgery or fiberoptic bronchoscopy.

PATIENT CONCERNS

We report a rare case of endobronchial hamartoma in which the clinical symptoms and imaging overlapped strongly with malignant lung tumor contralateral endobronchial metastasis.

DIAGNOSES

Endobronchial hamartoma coexisting with a malignant lung tumor.

INTERVENTIONS

Fiberoptic bronchoscopy was conducted, and the pathologic diagnosis was hamartoma. A second fiberoptic bronchoscopy was conducted, and fine-needle aspiration cytology of the enlarged lymph nodes indicated squamous cell carcinoma.

OUTCOMES

The clinical symptoms were relieved, and the treatment options were docetaxel, cis-dichlorodiamineplatinum, and endostatin.

LESSONS

Fiberoptic bronchoscopy needs to be guided by imaging and can be considered an effective method for the diagnosis of endobronchial hamartoma.

Diagnostic value of using multiplanar reformation images: Case report for rare endotracheal hamartomas

RATIONALE

Pulmonary hamartomas are the most common benign tumor of the lung. Two types of pathologically similar hamartomas exist based on their location. These tumors have a low incidence, are rarely reported and frequently misdiagnosed because of lack of familiarity and/or understanding concerning their imaging features.

PATIENT CONCERNS

Seventeen patients received treatment between June 2007 and May 2013 and had complete medical records. All of them had different degrees of cough and expectoration. Other symptoms include fever (5 cases), hemoptysis (4 cases), chest pain (3 cases), shortness of breath (2 cases), and dyspnea (1 case).

DIAGNOSES

These patients all have pathologically confirmed, and informed the diagnosis of endobronchial hamartoma.

INTERVENTIONS

Unenhanced and enhanced CT scans were performed using Toshiba Aquilion 64-slice and GE Lightspeed 64-slice CT scanners. The scan was performed from the superior thoracic aperture to the lateral costophrenic angle. The transaxial CT data was inserted into a Volume Wizard workstation to reconstruct images using MPR technique.

OUTCOMES

The relationship between the location of the tumor and bronchi was clearly displayed on the axial images in only 2 patients. In all 17 patients, reconstructed MPR images were able to display the tumor parallel to the long axis of bronchi, thus facilitating in tumor identification and positioning along the bronchial tree.

LESSONS

MPR images are valuable tools in the diagnosis of endobronchial hamartomas. Chiefly, these reconstructions aid in the detection of intratumoral fat/calcification and clearly demonstrate the tumors relationship and effect with the adjacent bronchi.

Central airway pathology: clinic features, CT findings with pathologic and virtual endoscopy correlation

Objectives

To describe the imaging features of the central airway pathology, correlating the findings with those in pathology and virtual endoscopy. To propose a schematic and practical approach to reach diagnoses, placing strong emphasis on multidetector computed tomography (MDCT) findings.

Methods

We reviewed our thoracic pathology database and the central airway pathology-related literature. Best cases were selected to illustrate the main features of each disease. MDCT was performed in all cases. Multiplanar and volume-rendering reconstructions were obtained when necessary. Virtual endoscopy was obtained from the CT with dedicated software.

Results

Pathological conditions affecting the central airways are a heterogeneous group of diseases. Focal alterations include benign neoplasms, malignant neoplasms, and non-neoplastic conditions. Diffuse abnormalities are divided into those that produce dilation and those that produce stenosis and tracheobronchomalacia. Direct bronchoscopy (DB) visualises the mucosal layer and is an important diagnostic and therapeutic weapon. However, assessing the deep layers or the adjacent tissue is not possible. MDCT and post-processing techniques such as virtual bronchoscopy (VB) provide an excellent evaluation of the airway wall.

Conclusion

This review presents the complete spectrum of the central airway pathology with its clinical, pathological and radiological features.

Teaching points

• Dividing diseases into diffuse and focal lesions helps narrow the differential diagnosis.

• Focal lesions with nodularity are more likely to correspond to tumours.

• Focal lesions with stenosis are more likely to correspond to inflammatory disease.

• Posterior wall involvement is the main feature in diffuse lesions with stenosis.

Large multicystic pulmonary chondroid hamartoma in a child presenting as pneumothorax

We describe a 10-year-old boy with a rare large multicystic pulmonary chondroid hamartoma in the right lower lobe presenting with severe respiratory distress. The radiological evaluation showed a large multicystic lesion in the right lower lobe with pneumothorax. Commonly, pulmonary hamartomas are asymptomatic, small in size, and are diagnosed incidentally in adults. Our case is highly unusual due to its young age, prominent clinical symptoms of severe respiratory distress with pneumothorax at presentation, very large size, and prominent cystic change. The lesion was surgically excised, and histopathological features were compatible with a multicystic chondroid hamartoma.

Endobronchial hamartoma: a rare disease with more common presentation

Hamartomas are the most common benign tumours of the lung with an overall incidence of 0.025-0.32%. They are known to be amalgamation of various tissue types, originating from the embryonic mesoderm. Lung hamartomas typically involve lung parenchyma and only infrequently grows as endobronchial tumours. We present a case of an 80-year-old man who presented to the pulmonary clinic for consultation for breathlessness, recurrent pneumonias and an abnormal radiograph finding. CT scan of the chest showed scattered infiltrates and atelectasis in the left upper lobe. He underwent a diagnostic bronchoscopy that showed a lobulated endobronchial lesion obstructing the left upper lobe bronchus. Brush and forceps biopsies were obtained that were consistent with an endobronchial hamartoma. He was referred to the pulmonology department for endobronchial debulking of the lesion following which he improved clinically during postoperative follow-up.

Pulmonary Hamartoma Mimicking Malignancy: A Cytopathological Diagnosis

Pulmonary Hamartomas (PH) are benign tumour-like lesions of lung with an uncommon occurrence and pose a diagnostic challenge on chest radiograph. Fine Needle Aspiration Cytology (FNAC) can lead to a definitive diagnosis as well as distinguishes these from malignant lung mass. Most of the patients are asymptomatic and incidentally detected on routine chest radiographs. We report a case of pulmonary hamartoma where the patient was symptomatic and a possibility of malignant neoplasm was considered until the FNAC concluded the diagnosis.

Tracheobronchial tumors

Tumors of trachea and bronchi are uncommon and can occur in the form of benign or low- and high-grade malignant tumors. Although tracheobronchial tumors (TBTs) represent only 0.6% of all pulmonary tumors, they are clinically significant. Delays in diagnosis of these tumors commonly occur because the signs and symptoms caused by these tumors are nonspecific and chest radiographs are often considered unremarkable. Therefore, novel radiological techniques and better access to flexible bronchoscopy enable detection of larger number of TBT. The purpose of this article is to provide a review of tracheal and bronchial tumors and discuss significant aspects of the different TBT with focus on clinical manifestations and diagnostic procedures.

Cold snare resection for the treatment of benign airway lesions

The objective was to assess the safety and outcome of cold snare technique used by flexible bronchoscopy in the treatment of airway benign neoplasms. The clinical data of 21 patients, who had airway benign neoplasm and were treated through the cold snare method in Sir Run Run Shaw Hospital, affiliated with the Zhejiang University, were retrospectively analyzed. The relief of the symptoms and occurrence of complications were observed and evaluated. All the tumors were benign and removed by cold snare. Postoperatively, we found that the treatment was completely effective in 12 patients, and there was a significant improvement in 7 patients and a moderate improvement in 2 patients, and no recurrence in follow-up visit. In conclusion, the cold snare technique is an economically feasible, safe, and effective method in the treatment of airway neoplasms.

Endobronchial Hamartoma Subtotally Occluding the Right Main Bronchus and Mimicking Bronchial Carcinoid Tumor

Hamartomas are very rarely identified as an endobronchial lesion. Herein, we describe a peculiar case of a 55-year-old woman with persistent cough and increasing dyspnea and radiological detection of a solid lesion subtotally occluding the main right bronchus. Despite the radiological and radiometabolic (18-fluoro-2-deoxy-d-glucose positron emission tomography/computer tomography scan) features were highly suspected for bronchial carcinoid, the definitive diagnosis after endoscopic removal was indicative of an endobronchial hamartoma. When considering differential diagnosis of an endobronchial lesion, the physicians should take firmly in mind such rare entity and, accordingly, bronchoscopy and bronchoscopic biopsy should be done as first step in management of all cases presenting with endobronchial lesions.

Multiple endobronchial hamartoma

BACKGROUND AND AIMS

Pulmonary hamartomas appear as parenchymal or endobronchial lesions, the latter representing '1.4 to 11%' of the total number of pulmonary hamartomas. Endobronchial hamartomas usually emerge as a single mass. As they are accepted as benign tumors, endobronchial treatments are recommended today. 45 year-old male patient admitted with cough, phlegm and fever. A lesion totally obstructing the right main bronchus was found in CT.

METHODS

In his brochoscopy, a mobile, smooth-surfaced lesion obstructing right main bronchus was seen. Its histopathology was reported as 'hamartoma.'

RESULTS

The lesion was removed by using argon plasma coagulation and electrocotery. After the removal of the lesion in right main bronchus, another lesion with similar characteristics was seen in the intermedius bronchus and this lesion which histopathology was reported as 'hamartoma' was excised by using electrocauter snare. There was no recurrence in the 24 month follow-up.

CONCLUSION

Reports of multiple endobronchial hamartomas are rare in the literature, and the awareness of this form of benign disease is important in the differential diagnosis of pulmonary diseases.

Successful removal of a giant pulmonary hamartoma coexisting with an anomalous common pulmonary venous trunk

We present an extremely rare case of a giant pulmonary hamartoma (PH) coexisting with an anomalous common pulmonary venous trunk (ACPVT). An asymptomatic 39-year-old man was referred for evaluation of a giant pulmonary lesion in his left thorax detected on chest X-ray during a routine medical examination. After clinical work-up, the patient underwent left exploratory thoracotomy. Since the extent of the tumor and coexistence of an ACPVT, a left pneumonectomy was performed. The specimen measured 28 cm × 18 cm × 17 cm and weighted for 2.1 kg. Histology revealed a blend of pieces of rounded cartilage separated by fibrous bands in which mature adipose tissue and cleft-like structures lined. The features were consistent with those of a chondromatous hamartoma. The patient made a satisfactory recovery and 10 months after the operation was asymptomatic.

Evaluation of the results of surgery treatment in patients with benign lung tumors

Background:

Lung tumors are among the common tumors and can be benign or malignant. Benign lung tumors are less common compared to the malignant types. Recognition of the clinical symptoms, types of tumors, paraclinical findings, and treatment approaches can bring better therapeutic results. The present study aims to evaluate the characteristics, diagnosis methods, and therapeutic approaches of different benign lung tumors.

Materials and Methods:

In this retrospective study, 32 patients with a diagnosis of benign lung tumor, who had been referred to the Mashhad University of Medical Sciences between 1981 and 2009, were studied. Some of the studied variables were symptoms, the pulmonary location involved, surgery technique, pathology findings, recurrence, and surgery complications. Data were analyzed by SPSS package version 16.

Results:

The average age of the patients was 51.69 ± 20.5 years. Prevalence of benign lung tumors was equal in both genders. The most common symptom was cough (31.2%); right lung involvement was more common (71.9%), and the most common sampling technique was transbronchial lung biopsy (TBLB) (62.5%); 53.1% of the patients were operated on by thoracotomy and the wedge resection technique. In 78.1% of the patients, no complications occurred after surgery. There was no recurrence. Most operations were performed in one month after the start of the symptoms (68.8%).

Conclusions:

Benign lung tumors are commonly diagnosed by routine radiography because most of them are asymptomatic. The most common finding in radiography is the presence of mass in the lungs. Transbronchial lung biopsy is a valuable technique to be used for diagnosis. We chose thoracotomy and wedge resection for the treatment of patients. We recommend this approach as a useful method.

Endobronchial hamartoma as a cause of pneumonia

Patient: Male, 66

Final Diagnosis: Endobronchial hamartoma

Symptoms: Fever

Medication: —

Clinical Procedure: Flexible bronchoscopy • surgical resection

Specialty: Pulmonology

An unexpected cause of hemoptysis: endobronchial lipomatous hamartoma

Hamartomas are the most common benign tumors of the lung. Endobnronchial hamartomas are even rarer and infrequently causes hemoptysis. We report a case of endobronchial hamartoma that was originating from a segment bronchus and invisible in chest X-ray. A 63-year-old man was admitted to hospital with hemoptysis. A CT scan revealed endobronchial mass obstructing anterior bronchus of the right lower lob of the right lung. It wasn’t radiographically presented. Flexible bronchoscopy detected a polypoid mass (1.5x1.0 cm) that arising from the posterior wall of the anterior segment of right lower lob. Histopathologic examination revealed lipoumatous hamartoma. It was resected with an electro-surgical snare. Cryotherapy was applied to residual lesion on surface of the bronchus. The patient was successfully recovered. In conclusion, lipoumatous hamartoma may presented as rare cause of hemoptysis. Endoscopic treatment is safe and currently modality used for select cases.

Pulmonary hamartoma resembling multiple metastases: A case report

The current study presents the case of a patient with multiple pulmonary nodules as observed by computed tomography. Furthermore, a marginal increase in fluorodeoxyglucose uptake was identified by positron emission tomography. Due to the appearance of multiple small nodules and a history of radical nephrectomy, a hypothetical diagnosis of pulmonary metastasis of a previously excised renal carcinoma was determined, which was confirmed by biopsy. Video-assisted thoracoscopic surgical resection of the nodules was proposed and pathological examination exhibited an unforeseen and rare observation.

Two Cases of Diagnosis and Removal of Endobronchial Hamartoma by Cryotherapy via Flexible Bronchoscopy

Although endobronchial hamartoma is a rare benign tumor, most patients with endobronchial hamartoma have respiratory symptoms such as obstructive pneumonia, hemoptysis, cough, or dyspnea due to bronchial obstruction. It can cause irreversible post-obstructive pulmonary destruction, thus early diagnosis and treatment is very important. Recently, there have been cases of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and electrocautery procedures for bronchoscopic treatment of malignant or benign central airway obstruction with comparable therapeutic efficacy and few complications. Bronchoscopic cryotherapy is a newly developed technique for management of central airway obstruction. Moreover, it provides diagnostic methods with improving diagnostic yield and safety. We report two cases of endobronchial hamartoma, each diagnosed and definitively treated with bronchoscopic techniques. Endobronchial biopsy and removal was successfully performed by cryotherapy via flexible bronchoscopy without notable complications. Follow-up bronchoscopic examinations excluded residual or recurrent disease.